# Acute Lupus Pneumonitis and Severe Multisystem Complications: A Complex Inpatient Course

## TL;DR

A rare case of acute lupus pneumonitis in a patient with lupus highlights the complex challenges of diagnosis and treatment involving multiple body systems.

## Contribution

This case study contributes a detailed clinical example of acute lupus pneumonitis complicated by multisystem failure.

## Key findings

- Acute lupus pneumonitis can present with symptoms similar to infection and heart failure, complicating diagnosis.
- Multisystem complications in SLE patients require coordinated, multidisciplinary care for effective management.
- Early involvement of specialists improves outcomes in critically ill lupus patients with complex presentations.

## Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse systemic manifestations. Pulmonary involvement is common, but acute lupus pneumonitis (ALP) is rare, occurring in fewer than 5% of patients, and is associated with poor outcomes. We describe a 60-year-old woman with longstanding SLE/Sjögren’s overlap who presented with progressive dyspnea, pleuritic chest pain, and productive cough. Radiology revealed bilateral ground-glass opacities consistent with ALP. Her clinical course was complicated by superimposed infection, severe left ventricular dysfunction with decompensated heart failure, stage 2 acute kidney injury, and chronic small vessel cerebrovascular disease. She required intensive immunosuppression, antimicrobial therapy, and advanced cardiac support, with eventual stabilization and discharge. This case illustrates the diagnostic challenges of distinguishing ALP from infection and cardiogenic pulmonary oedema, the interplay of multisystem disease in SLE, and the importance of early multidisciplinary involvement in critically ill patients.